Course: ADN 140 Nursing Fundamentals FORMATIVE

DES MOINES AREA COMMUNITY COLLEGE

NURSING PROGRAM PRACTICUM EVALUATION

The practicum evaluation tool is used to document the students progress towards meeting practicum competencies
for the course. The evaluation is applicable to all practicum settings where a clinical instructor is present including,
but not limited to, acute care, long-term care, and community. When attending simulated clinical experiences, a tool
specifically designed to evaluate students in simulation will be utilized. The simulation evaluation tool scores will be
incorporated into the students summative practicum evaluation.

The practicum evaluation tool is divided into formative and summative sections. The emphasis during formative
evaluations is on monitoring progress/improvement towards achievement of criteria, whereas summative is a final
evaluation to determine if performance criteria have been met. The student is expected to retain the skills and
abilities of performance criteria achieved in previous courses.

FORMATIVE EVALUATIONS will be completed once (1 time) per week/practicum setting. If the student is in more
than one (1) practicum setting in a week, a formative evaluation will be completed for each practicum setting.
Additional formative evaluations may be completed at the discretion of the instructor. Formative evaluations include
student self-evaluation and instructor feedback. The performance criteria for the formative part of the evaluation
tool are:

SP (Satisfactory Progress) student demonstrates steady, consistent performance related to

identified clinical competencies. Student will receive the number score associated with the
competency.

NI (Needs Improvement) student needs to demonstrate more independent performance of clinical

competency on a continuing basis. Student requires much or repeated assistance/redirection and
requires verbal and/or physical cueing from instructor.
Student will receive a zero (0) for the competency.

Total score and percent will be calculated for each formative evaluation. A percentage of 79 or less requires a
remediation plan. Remediation may be required at the discretion of the instructor at any time regardless of the
percentage.

The SUMMATIVE EVALUATION will be completed at the end of the course. Percent for each formative evaluation
will be totaled and divided by the number of formative evaluations in the course.

In order to pass the practicum component of this course, the student must achieve a total average percentage of 78
or greater.

A total average percentage of 78 or less will result in a failure for the course. The performance criteria for the
summative part of the evaluation tool are:

S (Satisfactory) total average of 78% or greater

U (Unsatisfactory) total average of less than 78%

Completion of the current course requires meeting both practicum competencies and theory components
successfully.

Revised 7/2016, 12/2016

Course: ADN 140 Nursing Fundamentals FORMATIVE

DES MOINES AREA COMMUNITY COLLEGE

NURSING PROGRAM PRACTICUM EVALUATION
ADN 140 Nursing Fundamentals FORMATIVE EVALUATION

Student _______________Cassidy Vlieger___________________ Term _____________1___________

Date(s) ______4/18/17_________________ Clinical Location _______PI____________________________

Using the sub competencies (listed under each Global Concept) as a guide, student will provide one
example of how he/she met each of the seven global concepts. Student needs to address a different sub
competency each week.
Do not use any patient specific identifiers (name, initials, room number).

Communication

S NI
1. Communicates in a respectful manner. 5 0
2. Identifies common nonverbal and verbal therapeutic communication skills. 5 0
3. Identifies appropriate boundaries to develop a therapeutic nurse client relationship. 5 0
4. Identifies barriers to effective communication. 1 0
5. Utilizes appropriate documentation for care provided to clients with guidance. 1 0
Total Possible Points 17
Total points Achieved
Student examples and discussion of how Global concept was met:

I communicated in a respectful manner to staff, persons served and the rest of my group. We learned about and
saw some nonverbal communication techniques being used such as sign language for one that wouldnt listen to
verbal keys. We identified some potential barriers of communication when doing our modules for our tickets to
clinical.

Safe Practice

S NI
1. Uses principles of safe practice with guidance from faculty or staff 5 0
2. Follows infection control principles. 5 0
3. Recognizes special precautions for safe client care. 5 0
4. Identifies how to prevent injury to self and client. 5 0
5. Identifies how to report safety issues 1 0
Total Possible Points 21
Total points Achieved
Student examples and discussion of how Global concept was met:

I got to see some safety measures that were in place when I went to the North house. Almost everyone had a fob
key on their person and we later learned that was because our house had some elope risk persons served, this
meant that they would run away. We also were very diligent in washing our hands and I also carried around hand
sanitizer in my lab jacket pocket for that little extra clean. I got to see how the staff would write up and report a case
of behavior, like when someone was upset and did something that wasnt part of the norm for them.

Revised 7/2016, 12/2016

Course: ADN 140 Nursing Fundamentals FORMATIVE

Nursing Process

S NI
1. Collects and identifies client problems based on data collected 5 0
2. Implements nursing plan of care in a timely manner 5 0
3. Identifies goals/expected outcomes and interventions 1 0
4. Identifies the effects of nursing interventions on the client 1 0
Total Possible Points 12
Total points Achieved
Student examples and discussion of how Global concept was met:

I was able to look at their charts and find pertinent information about them that could help me with better
understanding the persons served. I got to see how one person served kept track of all her goals and what she had
to do every day. I got to see how well the staff worked together to provide the care needed for each person served.

Care Across the Life Span

S NI
1. Individualizes assessment based on age of client. 5 0
2. Identifies specific communication skills appropriate for developmental level of the client. 5 0
3. Adapts nursing cares to meet the needs of clients across the life span. 1 0
4. Recognizes individual teaching needs across the life span. 1 0
Total Possible Points 12
Total points Achieved
Student examples and discussion of how Global concept was met:

There were many different age groups living in the North house. Every person served may have been a different
age than how they acted because of their disabilities. Each person served had their own individual teaching and
plan for the day as far as what they were supposed to do. The staff said that they try to keep everyone on a normal
routine.

Professionalism

S NI
1. Identifies and follows related policies and procedures with guidance. 10 0
2. Identifies personal behaviors that have a positive or negative effect on client care. 5 0
3. Identifies role within the healthcare team. 1 0
4. Participates in clinical post-conferences/debriefing with direction. 5 0
Total Possible Points 21
Total points Achieved
Student examples and discussion of how Global concept was met:

I thought that I had a positive attitude throughout the day. I was really enjoying myself here. I also noted some
differences in how the healthcare team worked here and then how the healthcare team worked at long term care.
Every one of the staff was very friendly towards us and very helpful at answering our questions.

Revised 7/2016, 12/2016

Course: ADN 140 Nursing Fundamentals FORMATIVE

Culture

S NI
1. Demonstrates respect for the cultural beliefs and practices of others. 5 0
2. Is aware of personal cultural beliefs, values, and practices that may influence care 5 0
delivery.
3. Recognizes how culture impacts health behaviors of individuals. 1 0
4. Demonstrates understanding of what is culture 1 0
Total Possible Points 12
Total points Achieved
Student examples and discussion of how Global concept was met:

Everyones culture was different. They also had different values and things that were important to them. This was
most evident in how everyones room was laid out as far as how they were decorated. Everyones rooms really
showcased how they really acted certain ages instead of how old they really were.

Health Promotion

S NI
1. Identifies how health behaviors relate to client condition. 2 0
2. Identify available community and facility resources. 1 0
3. Collects health promotion information during assessments. 2 0
Total Possible Points 5
Total points Achieved
Student examples and discussion of how Global concept was met:

Some of the persons served had to do ROM activities that helped them with the health promotion. Everyone there
has a little different condition and they were all on varying degrees of severity. We got to look in their charts to see
what the facility did for each of them to help them be able to function at their best level.

Revised 7/2016, 12/2016

Course: ADN 140 Nursing Fundamentals FORMATIVE

Total Points for each Concept:

Communication ____/17

Safe Practice ____/21

Nursing Process ____/12

Care Across the Life Span ____/12

Professionalism ____21

Culture ____/12

Health Promotion ____/5

Total Points Achieved _____/100 = ___________________%

78% or higher = Satisfactory

Less than 78% = Requires remediation

Student Identified Strengths:

Ive had some experience with these conditions when I was in high school. For me this took me back to those days
and reminded me how much fun they were. This helped me to have a positive outlook.

Student Identified Areas for Growth:

I think it was hard for me to really think of activities that we could all do together when we went out into the
community because for me in the past I had had a schedule with different activities to do at different times.

Faculty comments:

Areas of Strength:

Revised 7/2016, 12/2016

Course: ADN 140 Nursing Fundamentals FORMATIVE

Identify Areas for Growth.

Faculty Name______________________________ Date________________

Revised 7/2016, 12/2016